Oral Cancer
Incidence Annually, oral cancer is diagnosed in 40,250 Americans, and it is estimated that 7,850 people die from the disease. It is more prevalent in African American men, and their survival rate is lower than that of white men. Oral cancer is more common after the age of 35, with 65 years being the average age of diagnosis. It is two times more common in men than women. The 5 year survival rate is 83% for localized cancer and 61% for all stages of cancer of the oral cavity and pharynx combined. Risk Factors Although the definitive cause of oral cancer is unknown, it has a number of predisposing factors. * Tobacco use ( the longer duration, greater the risk) * Frequent Alcohol consumption (reported by 75-80% of patients that develop oral cancer) * Prolonged sun exposure/outdoor occupations (reported by 30% of patients with lip cancer) * Irritation from the pipe stem resting on the lip is a factor in pipe smokers * Male vs. Female (More prevalent in males) * Human papillomavirus (HPV) contributes to 25% of oral cancer cases. HPV-associated oropharyngeal cancer is associated with multiple sex partners, especially multiple oral sex partners. Predisposing Factors related to specific location of cancer: * Lip- constant overexposure to sun, ruddy and fair complexion, recurrent herpetic lesions, irritation from pipe stem, syphilis, immunosupression. * Tongue- tobacco, alcohol, chronic irritation * Oral cavity- poor oral hygiene, tobacco usage (pipe and cigar smoking, snuff, chewing tobacco), chronic alcohol intake, chronic irritation (jagged tooth, ill-fitting prosthesis, chemical or mechanical irritants), human papillomavirus (HPV) Signs and Symptoms * General oral cancer: Sore throat or a feeling that something is stuck, sore mouth, voice changes, leukoplakia ("smoker's patch", white patch on the mouth mucosa or tongue), erythroplasia (red velvety patch on the mouth or tongue), asymptomatic neck mass, lump or thickening in the cheek, difficulty chewing and speaking (later signs) * Cancer of the lip: indurated-painless ulcer on the lip * Cancer of the tongue: ulcer or area of thickening, soreness or pain, increased salivation, slurred speech, dysphagia, toothache, earache (later sign) How is it diagnosed? Diagnostic tests are performed to identify oral dysplasias, which are precursors to oral cancer. Oral exfoliative cytologic study involves scraping the suspicious lesion and spreading the scraping on a slide for microscopic examination Toludine blue is another screening tool. It is applied topically, which stains the area, and the cancer cells take up the dye. A negative result from either of the mentioned tests rule out a malignant condition. Once cancer is diagnosed, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) are used in staging the oral cancer. Medical Treatments * Surgery: Surgery remains the most effective treatment. Some surgeries include: hemiglossectomy (removal of one half of the tongue), glossectomy (removal of the entire tongue), radical neck dissection (wide excision of the lymph nodes and their lymphatic channels), and a tracheostomy. * Chemotherapy and radiation are used together when there are positive margins, bone erosion, or positive lymph nodes. Brachytherapy with implanatations of radioactive seeds may be used to treat early-stage oral cancer * Palliative treatment may be the best management when the prognosis is poor, the cancer is inoperable, of the patient decides against surgery. Nursing Management (Nursing Process) 1.Nursing Assessment * Subjective data ** Past health history: Recurrent oral herpetic lesions, HPV infection or vaccination, syphilis, exposure to sunlight ** Medications: Immunosuppressants ** Functional health patterns: Use of alcohol or tobacco, smoking; poor oral hygiene; difficulty chewing food; mouth or tongue soreness or pain; toothaches; earache; neck stiffness; dysphagia; difficulty speaking; weight loss; reductions in oral intake * Objective data ** Indurated, painless ulcer on lip; painless neck mass ** Areas of thickening or roughness, ulcers, leukoplakia, or erythoplakia on the tongue or oral mucosa; limited movement of the tongue; increased salavation, drooling; slurred speech; foul breath odor ** Postive exfoliative smear cytology (microscopic examination of cells removed by scraping); positive biopsy 2. Nursing Diagnoses * Imbalanced nutrition: less than body requirements * Chronic pain * Anxiety * Ineffective health maintenance 3. Planning * The overall goals are that the patient with carcinoma of the oral cavity will ** 1. have a patent airway ** 2. be able to communicate ** 3. have adequate nutritional intake to promote wound healing ** 4. have relief of pain and discomfort 4. Nursing Implementation/Interventions * As nurses, we have a significant role in early detection and treatment of oral cancer. * Identify patients at risk (users of tobacco products, alcoholism, poor dental care, pipe smokers) and provide information regarding predisposing factors. * Because early detection of oral cancer is important, teach the patient to report unexplained pain or soreness of the mouth, unusal bleeding, dysphagia, sore throat, voice changes, or swelling or lump in the neck 5. Evaluation * The expected outcomes are that the patient with oral cancer will ** Have no respiratory complications ** Be able to communicate ** Maintain an adequate nutritional intake to promote wound healing ** Experience minimal pain and discomfort with eating, drinking, and talking